Efficacy and Safety of Different Revascularization Strategies in Patients with Non-ST-segment Elevation Myocardial Infarction with Multivessel Disease: a Systematic Review and Network Meta-analysis

Overview

Journal Postepy Kardiol Interwencyjnej

Publisher Termedia

Date 2025 Feb 3

PMID 39897011

Authors

Tingting Chen

Chen Lu

Jingli Mo

Ting Wang

Xiang Li

Ying Yang

Affiliations

Soon will be listed here.

Abstract

Introduction: The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial.

Aim: We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients.

Methods: We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction.

Results: Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38-0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30-0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37-0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07-1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40-1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34-0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40-0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02-1.85).

Conclusions: Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.

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